ABSTRACT The opioid crisis continues to ravage US communities with overdose deaths at an all-time high. Women are disproportionately affected by the opioid crisis due to increased pain sensitivity, physician prescribing practices, and self-medication, as well as a faster trajectory from opioid exposure to the development of opioid use disorder (OUD). The opioid overdose death rate among women has risen 492% since 1999, a higher rate than men (404%). However, research on approaches to increase initiation of life-saving medications for opioid use disorder (MOUD) among women is limited. The University of Kentucky proposes to establish the Women?s Clinical Research Center as part of the NIDA Justice Community Opioid Innovation Network (W-JCOIN). The overall goal of the W-JCOIN is to increase initiation and maintenance of MOUD among high-risk justice-involved women in the transition from jail to the community to reduce opioid relapse and overdose. As part of this NIH collaborative network, the W-JCOIN will lead a type 1 hybrid effectiveness and implementation trial to examine an innovative MOUD pre-treatment model using telehealth (alone and in combination with peer navigators) for justice-involved women in transition from jail to the community in 6 experimental and 3 comparison (Services as Usual-SAU) sites. The following aims guide the study: (1) Compare the effectiveness of MOUD Pre-Treatment Telehealth (alone versus in combination with Peer Navigators) to increase MOUD initiation and maintenance among high- risk, justice-involved women in the community after release relative to services as usual (SAU). (2) Estimate the incremental cost and cost effectiveness of MOUD Pre-Treatment Telehealth (alone and in combination with Peer Navigators) relative to SAU for high-risk justice involved women with OUD in achieving desired changes in clinical, public health, and public safety outcomes over one-year post-release. (3) Examine temporal changes in key implementation constructs hypothesized by the EPIS framework to influence successful innovation implementation. This application is supported by an experienced team of NIH funded investigators with a track record of engaging in NIH justice research cooperative. The research team is well-positioned to be active members of the JCOIN network to rapidly conduct studies on quality care for OUD, with special focus on underserved and understudied justice-involved women. The KY W-JCOIN has the potential for significant impact on the OUD treatment field by contributing empirical evidence on the effectiveness and implementation of innovative technologies to increase initiation and maintenance of life-saving medications during a critical, high-risk time of community re-entry among vulnerable, justice-involved women in both urban and non-urban communities. The long-term goal of this research is to increase the capacity for the justice system to respond to the opioid crisis through increased access to treatment to reduce opioid relapse and overdose.